Signs of the formation of a false joint. False joint after fracture: causes, treatment. Treatment of a false joint with the Ilizarov apparatus

A false joint after a fracture (neoarthrosis) is the most common and severe disease of the musculoskeletal system. Occurs as a complication in 15% of limb fractures due to abnormal fusion of bone parts during a fracture. A false joint after a fracture is especially common with lesions of the bones of the lower leg.

Reasons for education

When the diaphysis is destroyed, specialists fasten its halves with metal staples, pull it out and perform other measures for high-quality bone fusion. Under normal conditions, a broken bone helps to heal "" - an amorphous outgrowth of plastic connective fibers that connects the separated parts. But if they are not connected in the right way, then over time the edges of the fracture are smoothed and form a pseudo-joint. Often there is a growth of a thin layer of fibrosis on the surface of adjoining fragments. All this is placed in the synovial bag, mobile and painless.

Important! The main reason for the formation of a false joint is insufficient fixation of fragments of a broken bone.

Varieties

False joints, depending on the causes of occurrence, are congenital, traumatic and pathological.

Based on clinical radiology, the joints are:

Pseudoarthrosis - are formed as a result of incorrect accretion, differ in pain in the fracture bag, pain during movement and palpation. The X-ray clearly shows the gap of the fracture and "".
Fibrous - fibrogenesis predominates between parts of a broken bone. The mobility of diarthrosis is normal, however, fluoroscopy reveals a thin lumen at the site of the fracture.
Necrotic. Occur due to circulatory disorders after gunshot injuries or fractures of the diaphysis, predisposed to the appearance of necrosis.
Regenerative - painful changes due to osteotomy from increased stretching or inaccurate fixation during medical measures for lengthening.
True neoarthrosis. Formed on single-bone sections in the area of traumatic mobility. Fragments of the diaphysis are rubbed and polished, over time they become overgrown with fibers, a lumen is rubbed at the break, where the liquid flows.

Depending on the presence of purulent infection, uncomplicated pseudarthrosis and infected are isolated.

According to the stages of dynamics, there are:

Hypertrophic - the tops of the fragments are overgrown with fibrosis. Due to prolonged compression on the limb or with reduced dynamic activity of fragments.
Avascular - violation of hemodynamics in diarthrosis leads to pathological metamorphoses in osteogenesis, osteoporosis of fragments is created.

At the place of localization, the following subspecies of neoarthrosis are common:

False joint after hip fracture. Most often occurs in older women. This is associated with progressive osteoporosis during menopause. Treatment is effective only operatively - the degenerative surfaces of the newly formed diarthrosis are removed and the bones are again compared, fixing them.
False joint after . With an unfused fracture, it causes mainly aesthetic inconvenience - it does not always cause pain.
A false joint after a fracture of the lower leg - in the region of the non-united fracture of the fibula.
False joint after a fracture of the radius - localized in the forearm. It is often the basis of radial clubhand.
A false joint after a fracture of the humerus - without axial load, it affects the functionality of the hand more than well-being.
False joint after a fracture of the jaw - leads to a bite defect, difficulties in eating.
Ankle pseudo-joint is complicated by foot tucking, instability, pain syndrome and edema in the ankle diarthrosis.

Causes of neoarthrosis

One group of unnatural growths occurs due to metabolic problems, complications after clinical procedures, illiterate postoperative support (premature loading, removal of plaster). The other group is based on medical support errors and purulent complications. The basics of the disease are:

impaired hemodynamics at the site of the fracture;
expanded lumen between fragments;
penetration into the lumen of parts of soft fibers;
incorrect position of parts of diarthrosis after matching.

There are other reasons for neoarthrosis:

osteoporosis;
bone deformity during surgery;
body reaction to metal clips;
the presence of a foreign particle between the fragments;
high number of fragments;
reaction to taking certain medications after a fracture;
influence of other tissue injuries.

Symptoms of the disease

The main signs of a pseudo-joint are the unnatural lability of diarthrosis, which normally cannot move like this. Such an ailment is subtle and clearly expressed. The muscle strength of diarthrosis changes, shortening up to one inch is determined, the dynamism of the limb changes pathologically, which is especially noticeable when the disease is in the lower extremities - the leg turns up, the ability to stand on it disappears. The patient needs support with a cane or crutches.

Clinical practice knows patients who are able to rotate the foot 360 degrees at the site of pseudo-joint formation.

false joint treatment

Today, medicine has in its arsenal various methods of treating a false joint, but rarely does without a surgical operation.

For the diagnosis of a false joint, a personal approach is used, since the potential for regeneration in patients is very different. Treatment of pathology is considered in the complex of information and concomitant diseases:

Without complications, with slow fusion - conservative methods are applicable that correct associated ailments, as well as form the substrate.
Surgical intervention is prescribed with a reliable diagnosis of neoarthrosis. Today's technological diversity makes it possible for each patient to choose an individual support option.
Upon completion of the operation, a long recovery phase follows - it returns healthy endurance to stress to the affected diarthrosis. For this, a complex technique of physiotherapy and healing physical education is used.

A false joint, the treatment of which is carried out in a complex, heals faster. After all, it turns out to organize a constancy that prevents relapses.

Conservative help

When a false joint is formed, treatment after a fracture consists in taking medications that provide correction of painful transformations. Their effect is aimed at concomitant pathologies and osteosynthesis itself:

Hormones - glucocorticoids administered by electrophoresis or injection. Their action inhibits degenerative changes that interfere with the growth of dense. Associated diseases that interfere with the nutrition of the diaphysis and complicate the fracture are healed.
Drugs that have a positive effect on hemodynamics. They stimulate the metabolism on the scale of small vessels, accelerating the regeneration processes in the area of the fracture.
Means that accelerate rehabilitation.

Conservative methods are not effective in all cases. Treatment of a false joint of the tibia and other large bones is not carried out by internal methods due to their ineffectiveness. Immobilization in this variant does not lead to the formation of a bone substrate capable of consolidating the fractures.

The main method of assistance in such cases is operational.

Surgical therapy

Radical elimination of pathology creates conditions for proper bone fusion. With all the variety of operations, there are similarities:

Resection of deformed tissues.
For the secondary docking of the fragments, a barrier in the form of connective tissue is removed.
The possibility of combining fragments is established (strong tissue resorption excludes this method).
Hypotrophy is corrected using the Ilizarov technology, which allows fixing diarthrosis to create an fusion zone.
When after resection of neoplasms, a separate fixation is performed.
The femoral neck stands apart in the clinic of these pathologies - a false joint after a fracture of the femoral neck ends with a complete replacement of the hip diarthrosis.

Folk remedies

The surgical procedure for neoarthrosis is often recurrent. This is related to the biochemistry of osteopathologies. When a false joint is operated on, treatment with folk remedies will help recovery.

Comfrey roots are best for regeneration and elimination of edema. Pour the plant with vodka in a ratio of one to five and leave for three weeks. Take twenty-five drops three times a day.
Comfrey compresses are also effective. For three tablespoons of the plant, one and a half cups of boiling water, leave for half an hour and strain.
This ointment perfectly helps with neoarthrosis: one onion, 50 g of vegetable oil, 20 g of spruce resin, 15 g of copper sulphate powder. Pour into a bowl, stir and bring to a boil.

Description:

False joint (pseudoarthrosis; synonymous with pseudoarthrosis) is a violation of the continuity of the bone with the development of mobility unusual for this part of it.

Symptoms:

The gap between bone fragments that form a false joint is filled not with callus, but with connective tissue. With a long existence of a false joint, the mobility in it may increase, neoarthrosis (a new joint) is formed, in which there is a capsule, an articular cavity containing synovial fluid, and the articulating ends of the bone are covered with cartilage.

A characteristic symptom of false joints is the pathological mobility of the bone in its unusual section, more often along the diaphysis. The degree of this mobility is different: from barely noticeable to movements with a large amplitude. In some cases, clinical symptoms may be mild or absent (for example, with a false joint of one bone of the biosseous segment). Axial load during walking with a false joint of the lower limb usually causes pain. Congenital false joints, such as the bones of the lower extremities, most often the lower leg, appear when the child begins to walk. They are characterized by greater pathological mobility than with acquired false joints.

When establishing a diagnosis, in addition to clinical data, they are guided by the period required normally for the union of this type of fracture. After the expiration of this period, they speak of a slowly accreting or non-united fracture, and after a double or longer period, they speak of a false joint. X-ray examination is of decisive importance for the diagnosis of a false joint. Radiographs are necessarily performed in two mutually perpendicular projections, sometimes additional oblique projections are used, as well as tomography. The main radiological signs of a false joint: the absence of a bone callus connecting the ends of both fragments; rounding and smoothing of the ends of fragments or their conical shape (atrophic false joint); fusion of the medullary cavity at the ends of fragments (development of the endplate). Often the end of one fragment has a hemispherical shape and resembles an articular head, and the end of another is concave like a glenoid cavity. At the same time, the joint space (neoarthrosis) is clearly visible on the radiographs. Thickening of bone fragments in the area of the pseudoarthrosis gap, uneven contours of the gap itself, its small width are characteristic of a hypertrophic pseudoarthrosis. To assess the intensity of bone formation processes in the area of the false joint, a radionuclide study is used.

Causes of occurrence:

There are congenital and acquired false joints. It is believed that the basis of congenital false joints is an intrauterine violation of bone formation. Acquired false joints in most cases are a complication of bone fractures due to impaired fusion of fragments. Acquired false joints are divided into hypertrophic, atrophic and normotrophic. For the formation of a false joint, a significant divergence of bone fragments after their reposition, insufficient immobilization or its premature termination, excessively early loading on the damaged limb segment, suppuration in the fracture zone, and local disturbance of the blood supply to bone fragments are important. Less often, a false joint is formed after orthopedic operations on the bones, such as osteotomy, and with pathological fractures.

Treatment:

The treatment of a false joint is mainly surgical and depends on the type and location of the false joint. Various methods of osteosynthesis are used, usually in combination with bone grafting.

false joint(pseudoarthrosis; a synonym for pseudoarthrosis) is a violation of the continuity of the bone with the development of mobility unusual for this part of it. There are congenital and acquired false joints. It is believed that the basis of congenital false joints is an intrauterine violation of bone formation. Acquired false joints in most cases are a complication of bone fractures due to impaired fusion of fragments. Acquired false joints are divided into hypertrophic, atrophic and normotrophic. For the formation of a false joint, a significant divergence of bone fragments after their reposition, insufficient immobilization or its premature termination, excessively early loading on the damaged limb segment, suppuration in the fracture zone, and local disturbance of the blood supply to bone fragments are important. Less often, a false joint is formed after orthopedic operations on the bones, such as osteotomy, and with pathological fractures.

The treatment of a false joint is mainly surgical and depends on the type and location of the false joint. Various methods of osteosynthesis are used, usually in combination with bone grafting.

A false joint is a pathology in which there is a violation of the integrity of the bone, as a result of which it loses stability and becomes mobile. The second name of the pathological phenomenon used in medicine is pseudoarthrosis. A false joint can be cured, and in some cases conservative methods are sufficient.

Thanks to the use of modern equipment and medications, the patient has every chance to return to a full life, avoiding disability.

It is important to correctly diagnose, establish the causes of the development of pathology and eliminate them by starting treatment as early as possible.

Types and features of a false joint

A false joint is a pathological change in the tubular bone, as a result of which its continuity is lost and it becomes mobile. According to the international classification of diseases, this disease has the ICD code 10. It means:

Pathological nonunion of bone tissue after a fracture;
Bone fusion as a complication of other joint diseases;
Arthrodesis.

Distinguish fibrous and true false joint. With a fibrous false joint, a small gap is formed between the fragments of the damaged tubular bone, in which fibrous tissue begins to form. The ends of the fragments grow, transforming into bone plates that cover the medullary canal.

Sometimes bone fragments are covered with cartilaginous tissue, and a dense shell is formed around them, resembling an articular one in its structure. Synovial fluid can accumulate inside it. In this case, a fibro-synovial false type of joint is diagnosed. With this form of pathology, sclerosis of bone fragments can develop.

In addition, such a joint may be congenital or acquired. Congenital false joint type accounts for only 0.5% of all cases of the disease. The pathology is caused by a violation of the intrauterine formation of bone tissue.

At birth, their structure is broken, and by the age of 2-3 years, the bones lose their continuity. Most often, a false joint of the lower leg is congenital, but pathologies of the collarbone, elbow or thigh can be found.

An acquired false joint develops after a bone fracture, if it is incorrectly or not completely fused.

Acquired pseudoarthrosis is divided in turn into normotrophic, atrophic and hypertrophic.

Reasons for the development of a false joint

Doctors distinguish three main groups of factors that provoke the occurrence of a false joint.

Incorrect treatment of bone fractures. If fragments of a displaced fracture were incorrectly compared, interposition of soft tissues was not eliminated, and immobilization of the injured limb was not properly carried out, there is a risk of developing a false joint. Excessive physical activity and unacceptable loads during treatment, fixing the joint with a bandage, plaster or orthosis in the wrong position, changing the plaster splint too often or removing it prematurely can also lead to pathology.
Post-traumatic complications in severe trauma. These include the loss of bone tissue over a long area, crushing of the muscle tissues surrounding the bone, ruptures of blood vessels and nerve fibers with a deterioration in their nutrition, osteomyelitis and suppuration of tissues.
Insufficient blood supply to the bone after a fracture in the damaged area.

Separately, trophic causes of the formation of a false joint are distinguished. These are acute infectious diseases, such as syphilis or malaria, impaired calcium-phosphorus metabolism in bone tissues, diabetes mellitus, deficiency of certain vitamins and minerals.

With the innervation of blood vessels, vascular insufficiency often develops - this is another factor provoking the disease.

Intense X-ray irradiation has a depressing effect on the formation of new cells and slows down bone healing after injury. Often a false joint is formed when tissue trophism is disturbed.

Symptoms and treatment of false joint

Pathology can be recognized by the following signs:

Excessive mobility at the site of a bone fracture;
Atrophy of the surrounding damaged area of muscle tissue;
Swelling and dense scars;
Intensive proliferation of connective tissue at the fracture site.

On the x-ray, the gap between the bone fragments is clearly visible, bone growths are visible at their ends, signs of sclerosis are often noted, the medullary canal is fused.

Modern medicine offers a number of measures aimed at the conservative treatment of a false joint. These are electric current stimulation, magnetotherapy for joints, injections of various drugs. But it is rarely successful, a surgical operation is considered more reliable and effective in this pathology.

During surgical treatment, the method of compression osteosynthesis is mainly used. To achieve a positive result, the operation is performed no earlier than 8-12 months after the injury has completely healed and the tissues have recovered.

In the presence of scars fused with the bone at the fracture site, they are preliminarily excised and plastic surgery is performed to eliminate defects.

The key points of the operation are the correct alignment of the fragments and restoration of the patency of the bone marrow canal.

Treatment of a false joint with the Ilizarov apparatus

This method of treatment is also called extrafocal osteosynthesis. With the help of a special device, it is possible to bring the bone fragments as close as possible and accelerate them from fusion, avoiding surgical intervention. Bone restoration on the Ilizarov apparatus includes several stages.

Orthopedic wires are inserted into the limb of the patient, which fix the bone fragments.
In the following week, the tissues in the places where the spokes pass heal, and the natural convergence of the bone fragments begins. Under their pressure, connective tissues that interfere with fusion and the false joint itself are destroyed.
Then the process of callus formation and its ossification begins. This is the longest, passive period of treatment. The patient should avoid physical activity, eat well and lead a healthy lifestyle. It is useful to additionally take multivitamin complexes.
The final stage is rehabilitation. The doctor develops an individual program for the patient in order to quickly restore the function and mobility of the affected limb.

Osteosynthesis as a method of treatment of a false joint

Intra- and extramedullary osteosynthesis is used. In the first case, during the operation, damaged tissues are removed without blood clots and periosteum residues, the fragments are brought together and connected with a metal alloy pin, then the tissues are combined in layers and sutured. A small scar remains after the operation.

In the second case, the fragments are fastened with a fixing plate. After the bone has grown together, an operation is performed to remove the plate through a small incision.

Patient habits play an important role in the treatment and prevention of false joint. It is recommended to monitor nutrition, control weight and metabolism, give up bad habits and exercise within reasonable limits.

And the video in this article will talk about the role of false joints in osteosynthesis.

Types of false joints and features of their treatment

A false joint is not a disease, as people far from medicine believe, but a radiological term meaning pathological (abnormal) bone mobility in a certain section of the human skeleton. Such a violation occurs due to various reasons, it is congenital and acquired. In the article we will consider each type in more detail, talk about the causes, the mechanism of development of the pathology and its treatment.

Classification of false joints
Features of a congenital false joint
The main causes of a false joint
Symptoms of a false joint
False joint diagnostics
false joint treatment
Exercise therapy for false joint

Classification of false joints

In medicine, there are several ways to classify a false joint based on the nature of the damage, attitude towards infection, and other factors. Let's consider the classification in more detail.

Classification by type

Depending on the nature of the bone damage, traumatologists divide false joints into 6 categories.

True false joint. It is formed if, upon receiving an injury, bone fragments are covered with islands of cartilage tissue, followed by scarring. This pathology is characterized by bone deformity and its complete mobility. The latter feature leads to the fact that the bones "dangle" and normal fusion does not occur. Most often found in the humerus and femur.

Necrotic false joint. Accompanied by constant severe pain, loss of function of the injured limb and edema localized at the site of injury. It occurs when multiple bone fragments and crushing of adjacent soft tissues are formed during a fracture.

Forming false joint (another term is delayed consolidation). It is formed when the period of fusion of broken bones is exceeded. Accompanied by severe pain, aggravated even with minor physical exertion. It can be recognized on an x-ray (against the background of a weak callus, a fracture line will be clearly visible).

A tight false joint (in the medical literature it can be found under the names "fibrous" or "slit-like"). The most common pathology, which manifests itself if the average period of consolidation is exceeded twice. In this case, a gap is formed between the fused fragments of the bone and a false joint is formed. Pathology is manifested by mild or moderate pain and a slight dysfunction of the damaged bone.

Destruction of the bone marrow. A type of false joint that occurs when skeletal traction is incorrect (a treatment for fractures). Depending on the situation, it may show signs of a tight or necrotic pseudoarthrosis.

Pseudarthrosis. This pathology appears at the site of dislocations or intra-articular fractures, for example, with an injury in the area hip joint.

Classification according to the severity of callus

In this case, when designating the type of false joint, the nature of the formation of callus at the fracture site is taken into account. There are two kinds.

Hypertrophic - the callus is strongly pronounced, the adjacent blood vessels are almost not damaged, the position of the bone fragments is relatively stable. With this type of false joint pain of low or moderate intensity, slight physical exertion is possible.
Avascular - the callus is weakly expressed, bone fragments have a slight or moderate discrepancy, there are signs of osteoporosis. There is pathological mobility of the injured arm or leg, as well as deformity.

An avascular false joint, in contrast to a hypertrophic one, is formed when the bone is malnourished, which occurs during a fracture.

Classification according to the degree of infection

In most cases, a false joint creates favorable conditions for the penetration and reproduction of pathogenic microflora. As a result, inflammatory processes occur, and in advanced cases - purulent foci. In medicine, there are three types of false joint complicated by infection.

Uncomplicated - there are no noticeable symptoms of inflammation. May refer to tight false joints, but there is a possibility of infection in the near future.
Infected - there is a clear focus of the inflammatory process. An infected false joint is accompanied by an increase in local temperature, the formation of a tumor near the site of injury, increased sweating and malaise.
Purulent false joint - in the area of \u200b\u200bformation of the pathology, fistulas filled with pus are formed. Inflammatory processes, foreign bodies, and other aggravating factors may be present.

In addition to this classification, another can be applied. For example, in military surgery it is customary to divide false joints according to the nature of bone damage - gunshot or non-gunshot. Next, consider the features of a congenital false joint, since it does not fall under any category and is classified separately.

Features of a congenital false joint

If a false joint is detected in a newborn child, this indicates the presence of a rare and complex disease. The main cause of the pathology is a deviation in the intrauterine development of the fetus. Congenital false joint has two forms.

True - diagnosed immediately after birth when examining the baby.
Latent - in a certain area of \u200b\u200bthe bones, signs of sclerosis can be detected, later the bone breaks in the area of \u200b\u200bits dysplasia and a false joint is gradually formed.

Most often, a congenital false joint is formed in the shin area, less often in the thigh area with a dislocation of the hip joint. The latent form appears after the child begins to walk. During this period of life, the load on the bones increases, which leads to a fracture with the subsequent formation of pathology.

You can suspect something is wrong by the following symptoms:

limb mobility is higher than during normal development;
the affected limb is disproportionate to the other;
there are signs of atrophy (weakness) of the muscles in the area adjacent to the false joint;
with the progression of the pathology, the child cannot fully step on the foot.

A more accurate diagnosis is made on the basis of an X-ray examination. On x-rays, the affected area of \u200b\u200bthe bone will be clearly visible, and in some cases its curvature.

The main causes of a false joint

All types of false joint, with the exception of congenital, are formed after fractures. This is the only factor that can provoke the development of pathology. However, there are a number of other reasons, the presence of which increases the likelihood of cartilage formation in the area of a bone fracture. Most likely:

metabolic disorders;
endocrine diseases;
circulatory disorders;
multiple fractures;
disorders of innervation;
large distance between debris;
the presence of soft tissue between the two parts of the bone.

In addition, a false joint can also form with the wrong tactics for treating various fractures. For example, with early physical exertion, improperly selected counterweight during skeletal traction, or actions that led to infection.

As for pseudoarthrosis, it is formed if the dislocation of the joint has not been treated for a long time. Separately, it is worth mentioning palliative operations, for example, in case of a fracture of the femoral neck. If for some reason it is impossible to make arthroplasty, then doctors specifically seek the formation of pseudarthrosis to ensure the normal functioning of the limb.

Symptoms of a false joint

The clinical signs of the described pathology may differ depending on the type of false joint, we wrote about this above. Let's summarize what symptoms may be accompanied by a violation:

pain of varying intensity;
the appearance of a tumor;
an increase in local temperature;
signs of intoxication with a purulent false joint (nausea, weakness);
curvature of the injured limb.

In most cases, support and motor functions are lost - patients experience bouts of pain when they try to step on the injured leg, the limb does not bend, or vice versa, acquires pathological mobility.

It is not always possible to make a diagnosis based on these features. Therefore, in medical practice, instrumental diagnostics and other measures aimed at identifying pathology are used.

False joint diagnostics

The doctor makes a preliminary diagnosis on the basis of the initial examination and palpation. At this stage of the examination, an increase in local temperature, the presence of a tumor and soreness can be detected.

A more complete picture can be established using an x-ray examination. On x-rays taken in two projections (direct and oblique), the following signs of a false joint will be clearly visible:

delayed formation of callus (this takes into account the time of injury);
pathological osteosclerosis (increased bone density);
the presence of connecting plates in the bone marrow cavity;
bone growth in the area of false joint formation (a characteristic sign of hypertrophy);
curvature of the bones of the limb relative to the axis;
displacement of bone fragments;
osteoporosis (pathological decrease in bone density).

With a competent approach to diagnosing the problem, additional examinations may be needed to identify the cause of the formation of a false joint.

false joint treatment

Currently, there are no drugs that can eliminate the pathology. The same applies to all kinds of methods of traditional medicine, the use of which is not only useless, but also detrimental to the body. The only effective methods of treatment are surgical intervention and the imposition of the Ilizarov compression-distraction apparatus. In addition, auxiliary methods, for example, exercise therapy, can be used. Let's talk about each method in more detail.

The essence of the operation for a false joint

The technique of surgical intervention is chosen by the doctor and depends on the location of the false joint, its type and the period from the moment of formation. In most cases, the operation is performed under general anesthesia. Without going into details, the course of the operation is as follows.

After the anesthesia has taken effect, the surgeon makes an incision in the skin and muscles in the area of the pathology localization.
Having gained access to the false joint, the doctor removes the fibrous tissue between the parts of the bone.
Then economically cuts off the ends of the bone fragments.
Opens the medullary canal.
Fixes debris in an anatomically correct position.

In order for the bone to recover faster, in addition to fixation, homografts and autografts are used.

Osteoplasty for false joint

Osteoplasty is a surgical intervention, the purpose of which is the transplantation of bone tissue to restore the integrity of the bone or change its shape. Bone grafting accelerates the fusion of bones in case of fractures or resection, therefore, in most cases, this method completes the operation to eliminate the false joint.

As a material for subsequent transplantation, a part of the rib, femur or ilium of the patient (autoplasty) is used. Much less often, bone tissues of another patient or a corpse treated with low temperatures (homoplasty) are used.

In the surgery of false joints of different localization, bone chips are used. It is placed around the bone fragments, and later the damaged limb is fixed by applying a plaster cast.

Treatment with the Ilizarov apparatus

The Ilizarov apparatus is a complex instrument consisting of steel spokes and rings. With its help, the surgeon can not only stretch or compress certain parts of the bone, but also regulate the speed of fusion during fractures and operations. For this reason, the Ilizarov apparatus is often used after surgery for a false joint. There is clinical evidence of the effectiveness of this method.

The Ilizarov apparatus is installed on the injured limb as follows:

The doctor tells the patient about the features of the technique, takes written permission from him.
Blocks the transmission of nerve impulses using local or general anesthesia.
With the help of a special medical drill, two spokes of the device are screwed into the bone at an angle of 900 to each other.
Their ends, remaining outside, are fixed with the help of special rings.
Between the rings, it installs rods, with the help of which the speed of fusion of bone fragments is regulated.

The duration of wearing the Ilizarov apparatus in the treatment of a false joint depends on the severity of the pathology and the effect that the doctor plans to achieve. The first two weeks the patient is in the hospital department, then he is discharged home without removing the apparatus.

From the moment the doctor begins to adjust the distance between the rings, discomfort may begin. For severe pain, a course of painkillers is recommended. Antibiotics are prescribed to prevent infection. The device itself needs care, which consists in the disinfection of metal parts with the help of medical alcohol. At home, you can use vodka.

With normal bone fusion, pain and discomfort disappear within 3-7 days. If this does not happen, you need to see a doctor. In this case, the apparatus is removed to avoid the development of the inflammatory process and to exclude complications.

If the process proceeds normally and there are no complications, the Ilizarov apparatus remains on the limb for the entire period of treatment. Then the doctor removes it, bites the needles and applies a cast. In the future, for faster recovery, exercise therapy and therapeutic massage are prescribed.

Exercise therapy for false joint

Exercise therapy (physiotherapy exercises) is an auxiliary method for the treatment of a false joint. Physical exercises are selected taking into account the localization of the pathology and the result to be achieved. The term for the appointment of exercise therapy is different, the doctor focuses on the result of the examination, so as not to start the exercises ahead of time. Otherwise, a recurrence of the formation of a false joint is possible.

As an example, consider physiotherapy exercises prescribed for fractures in the hip area. It will also be prescribed for the localization of the false joint of the femur. In this case, the treatment period is divided into three periods, each of which differs in the types of exercises.

First period of exercise therapy

A set of exercises for the first period of exercise therapy:

flexion and extension of the foot;
flexion and extension of the toes;
tension and relaxation of the muscles of the injured limb.

To prevent the development of bedsores, as well as strengthen the whole body, respiratory gymnastics and other exercises are prescribed. Usually they are carried out under the supervision of medical personnel, who makes sure that the patient does not exceed the permissible load and does not violate the recovery regimen.

In the first period of exercise therapy, all exercises are performed in the "lying on the back" position.

Stretch your arms along the body, raise them up and inhale. Lower down and exhale. Repeat 8 times.
Raise your arms in front of your chest, bend at the elbows. Simulate punches like in boxing 12 times.
Tilt your head forward and try to reach your chest with your chin 8 times.
Squeeze your fingers into a fist when inhaling, unclench when exhaling - 12 approaches.
Pull the foot of the uninjured leg to the pelvis, without tearing them off the horizontal surface - 12 approaches.
Bend your healthy leg at the knee 10 times without lifting your heels from a horizontal surface.
Bend and unbend the big toe 10 times.
Throw your hands behind your head while inhaling, return to the starting position while exhaling - 12 approaches.
Inhaling, engage the abdominal muscles and chest (male type of breathing).
Inhale and exhale holding your breath for 2-3 seconds.
Alternately tighten and relax the muscles of the buttocks and the quadriceps femoris.

During the first period of exercise therapy, blood circulation is restored, the blood is saturated with oxygen, and the functions of internal organs are normalized. This facilitates the patient's condition and speeds up recovery after surgery.

The second period of exercise therapy

The second and third periods begin from the moment the plaster is applied. The previous exercises remain, but new ones are added to them. The position of the body is the same as in the first period.

Put your hands on the back of your head, interlace your fingers in the lock. While inhaling, straighten your arms, while exhaling, return to the starting position. Requires 10 sets.
Imagine that you are stretching a rubber band with your hands. Perform similar movements 8 times.
Mentally bend, unbend, take the leg to the side in the hip and ankle joints. Muscles should tense up.
Grasp the edge of the bed with your hands, lift the torso up as you inhale, lower it as you exhale. Requires 10 sets.
Pick up an object in your hand and pass it to an assistant, then take it back.
Breathe using your chest.
Bend a healthy limb, rest your hands on the edge of the bed. Carefully lift the pelvis and the cast leg, leaning on the healthy limb as well. It takes 10 approaches, you can do it with short breaks.
With the help of an assistant, turn the body to the left and right in 6 sets.
Place a piece of plywood or a board under the plastered leg, gently press on it with your foot. The number of approaches up to 10 times.

All exercises should be carried out with the help of a medical professional or relatives. It must be remembered that careless movements can lead to improper fusion of the bone.

The third period of exercise therapy

At this stage, the patient can already rise and roll over, so the initial position of the body is different. Exercises remain the same and new ones are added to them.

Lying on your back, make circular movements with your hands 10 times.
Raise your arms up as you inhale and release as you exhale 8 times.
Leaning on the hands, the back of the head and a healthy leg, raise the pelvis and the plastered limb 10 times.
Breathe using the abdominal muscles. Control inhalation and exhalation with the palms of the hands (put one on the chest, the second on the stomach).
Try to roll over on your stomach on your own, then return to the starting position. You need at least four approaches, but six is better.
Lie on your stomach, rest your hands and toes on the bed. Push up to straighten your arms six times. You need to raise the body on the inhale, and lower it on the exhale.

During the entire course of exercise therapy, it is necessary to take measures so that there are no bedsores. To do this, you can use special ointments or put anti-decubitus pads under the buttocks and other vulnerable places.

A false joint or pseudoarthrosis is a serious pathology that requires complex surgical treatment and a long recovery period. Without treatment, there is a risk of developing necrosis, fractures and other complications. Therefore, if you have any of the symptoms described in the article, contact your surgeon. The doctor will be able to make an accurate diagnosis and prescribe treatment only after examining the x-ray.

Content:

Classification of false joints

In medicine, there are several ways to classify a false joint based on the nature of the damage, attitude towards infection, and other factors. Let's consider the classification in more detail.

Classification by type

Depending on the nature of the bone damage, traumatologists divide false joints into 6 categories.

True false joint. It is formed if, upon injury, bone fragments are covered with islands of cartilage tissue, followed by scarring. This pathology is characterized by bone deformity and its complete mobility. The latter feature leads to the fact that the bones "dangle" and normal fusion does not occur. Most often found in the humerus and femur.

Necrotic false joint. Accompanied by constant severe pain, loss of function of the injured limb and edema localized at the site of injury. It occurs when multiple bone fragments and crushing of adjacent soft tissues are formed during a fracture.

False joint in the forearm

Forming false joint(another term is slow consolidation). It is formed when the period of fusion of broken bones is exceeded. Accompanied by severe pain, aggravated even with minor physical exertion. It can be recognized on an x-ray (against the background of a weak callus, a fracture line will be clearly visible).

Tight false joint(in the medical literature it can be found under the names "fibrous" or "slit"). The most common pathology, which manifests itself if the average period of consolidation is exceeded twice. In this case, a gap is formed between the fused fragments of the bone and a false joint is formed. Pathology is manifested by mild or moderate pain and a slight dysfunction of the damaged bone.

Destruction of the callus. A type of false joint that occurs when skeletal traction is incorrect (a treatment for fractures). Depending on the situation, it may show signs of a tight or necrotic pseudoarthrosis.

Pseudarthrosis. This pathology appears at the site of dislocations or intra-articular fractures, for example, with an injury in the area.

Classification according to the severity of callus

In this case, when designating the type of false joint, the nature of the formation of callus at the fracture site is taken into account. There are two kinds.

Hypertrophic - the callus is strongly pronounced, the adjacent blood vessels are almost not damaged, the position of the bone fragments is relatively stable. With this type of false joint pain of low or moderate intensity, slight physical exertion is possible.
Avascular - the callus is weakly expressed, bone fragments have a slight or moderate discrepancy, there are signs of osteoporosis. There is pathological mobility of the injured arm or leg, as well as deformity.

An avascular false joint, in contrast to a hypertrophic one, is formed when the bone is malnourished, which occurs during a fracture.

Classification according to the degree of infection

Uncomplicated - there are no noticeable symptoms of inflammation. May refer to tight false joints, but there is a possibility of infection in the near future.
Infected - there is a clear focus of the inflammatory process. An infected false joint is accompanied by an increase in local temperature, the formation of a tumor near the site of injury, increased sweating and malaise.
Purulent false joint - in the area of \u200b\u200bformation of the pathology, fistulas filled with pus are formed. Inflammatory processes, foreign bodies, and other aggravating factors may be present.

Formation of a false joint on the toe

Features of a congenital false joint

True - diagnosed immediately after birth when examining the baby.
Latent - in a certain area of \u200b\u200bthe bones, signs of sclerosis can be detected, later the bone breaks in the area of \u200b\u200bits dysplasia and a false joint is gradually formed.

You can suspect something is wrong by the following symptoms:

limb mobility is higher than during normal development;
the affected limb is disproportionate to the other;
there are signs of atrophy (weakness) of the muscles in the area adjacent to the false joint;
with the progression of the pathology, the child cannot fully step on the foot.

A more accurate diagnosis is made on the basis of an X-ray examination. On x-rays, the affected area of \u200b\u200bthe bone will be clearly visible, and in some cases its curvature.

The main causes of a false joint

metabolic disorders;
endocrine diseases;
circulatory disorders;
multiple fractures;
disorders of innervation;
large distance between debris;
the presence of soft tissue between the two parts of the bone.

The clinical signs of the described pathology may differ depending on the type of false joint, we wrote about this above. Let's summarize what symptoms may be accompanied by a violation:

pain of varying intensity;
the appearance of a tumor;
an increase in local temperature;
signs of intoxication with a purulent false joint (nausea, weakness);
curvature of the injured limb.

In most cases, support and motor functions are lost - patients experience when they try to step on the injured leg, the limb does not bend or, on the contrary, acquires pathological mobility.

Muscle atrophy in the area of false joint formation

It is not always possible to make a diagnosis based on these features. Therefore, in medical practice, instrumental diagnostics and other measures aimed at identifying pathology are used.

False joint diagnostics

A more complete picture can be established using an x-ray examination. On x-rays taken in two projections (direct and oblique), the following signs of a false joint will be clearly visible:

delayed formation of callus (this takes into account the time of injury);
pathological osteosclerosis (increased bone density);
the presence of connecting plates in the bone marrow cavity;
bone growth in the area of false joint formation (a characteristic sign of hypertrophy);
curvature of the bones of the limb relative to the axis;
displacement of bone fragments;
osteoporosis (pathological decrease in bone density).

With a competent approach to diagnosing the problem, additional examinations may be needed to identify the cause of the formation of a false joint.

false joint treatment

The essence of the operation for a false joint

After the anesthesia has taken effect, the surgeon makes an incision in the skin and muscles in the area of the pathology localization.
Having gained access to the false joint, the doctor removes the fibrous tissue between the parts of the bone.
Then economically cuts off the ends of the bone fragments.
Opens the medullary canal.
Fixes debris in an anatomically correct position.

In order for the bone to recover faster, in addition to fixation, homografts and autografts are used.

Preparation for osteoplasty of the false joint

Osteoplasty for false joint

In the surgery of false joints of different localization, bone chips are used. It is placed around the bone fragments, and later the damaged limb is fixed by applying a plaster cast.

Treatment with the Ilizarov apparatus

The Ilizarov apparatus is installed on the injured limb as follows:

The doctor tells the patient about the features of the technique, takes written permission from him.
Blocks the transmission of nerve impulses using local or general anesthesia.
With the help of a special medical drill, two spokes of the device are screwed into the bone at an angle of 90 0 to each other.
Their ends, remaining outside, are fixed with the help of special rings.
Between the rings, it installs rods, with the help of which the speed of fusion of bone fragments is regulated.

Treatment of a false joint with the Ilizarov apparatus

First period of exercise therapy

A set of exercises for the first period of exercise therapy:

flexion and extension of the foot;
flexion and extension of the toes;
tension and relaxation of the muscles of the injured limb.

In the first period of exercise therapy, all exercises are performed in the "lying on the back" position.

Stretch your arms along the body, raise them up and inhale. Lower down and exhale. Repeat 8 times.
Raise your arms in front of your chest, bend at the elbows. Simulate punches like in boxing 12 times.
Tilt your head forward and try to reach your chest with your chin 8 times.
Squeeze your fingers into a fist when inhaling, unclench when exhaling - 12 approaches.
Pull the foot of the uninjured leg to the pelvis, without tearing them off the horizontal surface - 12 approaches.
Bend your healthy leg at the knee 10 times without lifting your heels from a horizontal surface.
Bend and unbend the big toe 10 times.
Throw your hands behind your head while inhaling, return to the starting position while exhaling - 12 approaches.
Inhaling, engage the abdominal muscles and chest (male type of breathing).
Inhale and exhale holding your breath for 2-3 seconds.
Alternately tighten and relax the muscles of the buttocks and the quadriceps femoris.

A set of exercise therapy exercises in the treatment of hip pathologies

The second period of exercise therapy

The second and third periods begin from the moment the plaster is applied. The previous exercises remain, but new ones are added to them. The position of the body is the same as in the first period.

Put your hands on the back of your head, interlace your fingers in the lock. While inhaling, straighten your arms, while exhaling, return to the starting position. Requires 10 sets.
Imagine that you are stretching a rubber band with your hands. Perform similar movements 8 times.
Mentally bend, unbend, take the leg to the side in the hip and ankle joints. Muscles should tense up.
Grasp the edge of the bed with your hands, lift the torso up as you inhale, lower it as you exhale. Requires 10 sets.
Pick up an object in your hand and pass it to an assistant, then take it back.
Breathe using your chest.
Bend a healthy limb, rest your hands on the edge of the bed. Carefully lift the pelvis and the cast leg, leaning on the healthy limb as well. It takes 10 approaches, you can do it with short breaks.
With the help of an assistant, turn the body to the left and right in 6 sets.
Place a piece of plywood or a board under the plastered leg, gently press on it with your foot. The number of approaches up to 10 times.

All exercises should be carried out with the help of a medical professional or relatives. It must be remembered that careless movements can lead to improper fusion of the bone.

The third period of exercise therapy

At this stage, the patient can already rise and roll over, so the initial position of the body is different. Exercises remain the same and new ones are added to them.

Lying on your back, make circular movements with your hands 10 times.
Raise your arms up as you inhale and release as you exhale 8 times.
Leaning on the hands, the back of the head and a healthy leg, raise the pelvis and the plastered limb 10 times.
Breathe using the abdominal muscles. Control inhalation and exhalation with the palms of the hands (put one on the chest, the second on the stomach).
Try to roll over on your stomach on your own, then return to the starting position. You need at least four approaches, but six is better.
Lie on your stomach, rest your hands and toes on the bed. Push up to straighten your arms six times. You need to raise the body on the inhale, and lower it on the exhale.